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Scalp nerve blocks for external ventricular drainage placement in children
Hande Gurbuz1, Elif Basaran Gundogdu2, Derya Karasu3
1Department of Anesthesiology and Reanimation, Bursa School of Medicine, Bursa City Hospital, University of Health Sciences, Bursa, 16110, Türkiye. handegrbz@gmail.com.
Insights
Scalp nerve blocks (SNB) with sedation offer a safer alternative to general anesthesia for pediatric external ventricular drainage (EVD) placement. This method reduced pain responses and analgesic needs, preserving spontaneous ventilation.
Area of Science:
- Pediatric Anesthesiology
- Neurosurgery
- Pain Management
Background:
- External ventricular drainage (EVD) placement in pediatric patients typically requires general anesthesia, posing risks like airway instability.
- Scalp nerve blocks (SNB) with sedation present a potential alternative, aiming to mitigate risks associated with general anesthesia.
- SNB may also reduce the need for postoperative pain medication compared to traditional incision-site infiltration.
Purpose of the Study:
- To compare perioperative outcomes of EVD placement in pediatric patients using SNB with sedation versus general anesthesia with incision-site infiltration.
- To evaluate the efficacy and safety of SNB as a primary anesthetic technique for EVD procedures.
- To assess differences in analgesic requirements, hemodynamic responses, and need for anesthesia conversion.
Main Methods:
- A prospective observational study analyzing 63 EVD placements in children under 8 years old.
- Patients were divided into two groups: SNB with sedation (n=29) and general anesthesia with incision-site infiltration (n=34).
- Key outcomes measured included postoperative analgesic needs, total analgesic consumption, heart rate response to incision, and conversion rates to general anesthesia.
Main Results:
- SNB significantly reduced heart rate response to surgical stimulus compared to incision-site infiltration (3.4% vs. 73.5%, p<0.001).
- Patients receiving SNB required significantly less postoperative analgesia and had lower total consumption in the first 24 hours (p<0.001).
- No procedures under SNB required conversion to general anesthesia, and intraoperative opioid use was lower.
Conclusions:
- Scalp nerve blocks combined with sedation are a feasible alternative to general anesthesia for pediatric EVD placement.
- SNB demonstrated reduced nociceptive responses, lower postoperative analgesic requirements, and decreased intraoperative opioid use.
- This technique effectively preserved spontaneous ventilation, enhancing patient safety during EVD procedures.
Background:
External ventricular drainage (EVD) placement is usually performed in the operating room under general anesthesia with endotracheal intubation in pediatric patients with elevated intracranial pressure. Scalp nerve blocks (SNB) with sedation can avoid the safety concerns and complications associated with general anesthesia, such as airway and hemodynamic imbalance. Moreover, SNB can offer a reduced analgesic need when compared with incision-site infiltration. This prospective observational study aimed to compare perioperative outcomes between SNB with sedation and general anesthesia with incision-site infiltration for EVD placement in pediatric patients.
Methods:
Data from 63 EVD placement procedures performed in children under 8 years of age either under sedation with SNB (n = 29) or under general anesthesia with incision-site infiltration (n = 34) were analyzed. Outcomes included need for postoperative analgesics, total analgesic consumption in the first 24 h postoperatively, heart rate response to surgical incision, and the requirement for conversion to general anesthesia.
Results:
Compared with incision-site infiltration, the incidence of heart rate response to surgical stimulus was significantly lower in patients with SNB (3.4% vs. 73.5%, p < 0.001). Postoperative analgesic requirement and total analgesic consumption within the first 24 h were also lower in the SNB group (both p < 0.001), with an absolute risk reduction of 47.4%. Compared with patients receiving SNB, those receiving incision-site infiltration had higher odds of postoperative analgesic requirement (OR 8.6, 95% CI 3.2-25.0, p < 0.001); however, this association was attenuated after adjustment for intraoperative fentanyl (OR 2.4, 95% CI 0.2-33.3, p = 0.49). No procedures required conversion to general anesthesia.
Conclusions:
SNB combined with sedation may represent a feasible alternative to general anesthesia for pediatric EVD placement. Lower rates of nociceptive responses and postoperative analgesic requirements, as well as lower intraoperative opioid use, were observed in patients receiving SNB, while spontaneous ventilation was preserved throughout the procedure.
